| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
415 |
407 |
$2K |
| 86580 |
|
453 |
450 |
$1K |
| 36425 |
|
458 |
455 |
$755.86 |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
14 |
14 |
$700.00 |
| 90658 |
|
61 |
61 |
$529.82 |
| 90688 |
|
134 |
134 |
$167.89 |
| 90686 |
|
80 |
78 |
$164.10 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
24 |
24 |
$102.17 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
60 |
60 |
$92.38 |
| 90461 |
|
15 |
15 |
$90.00 |
| G0447 |
Face-to-face behavioral counseling for obesity, 15 minutes |
12 |
12 |
$45.04 |
| 99000 |
|
179 |
177 |
$0.00 |
| 99173 |
|
196 |
195 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$0.00 |